Provider Demographics
NPI:1942413711
Name:FRATARCANGELI, KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:FRATARCANGELI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 DIXWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-248-0072
Mailing Address - Fax:203-407-8063
Practice Address - Street 1:2559 DIXWELL AVENUE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-248-0072
Practice Address - Fax:203-407-8063
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice